Provider Demographics
NPI:1154865996
Name:PARK NICOLLET HEALTH CARE PRODUCTS
Entity Type:Organization
Organization Name:PARK NICOLLET HEALTH CARE PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LENAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-993-3108
Mailing Address - Street 1:3800 PARK NICOLLET BLVD
Mailing Address - Street 2:6WS01C
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2527
Mailing Address - Country:US
Mailing Address - Phone:952-993-6832
Mailing Address - Fax:952-993-0562
Practice Address - Street 1:15301 GROVE CIR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4475
Practice Address - Country:US
Practice Address - Phone:952-993-1460
Practice Address - Fax:952-993-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies